There are many frustrations and challenges associated with working in Angola, but sometimes I am confronted by something just plain fascinating. Apart from our work in rural Cavango, we also travel with Mission Aviation Fellowship (MAF) to remote people where evidence-based health care isn’t available. One of our monthly visits is to a place called Tchincombe, where our missionary colleagues, Donna and Stirling Foster, have been living and working among the Ovangambwe people group for over twenty years. One day last week we were enjoying a leisurely lunch with Donna and Stirling, away from the busy clinic for an hour, when a car pulled up to their gate (not many cars out there, and no roads – just sandy paths) and called for help. As we approached the car, we were told that one of the men inside had been attacked by a leopard!
Over the years I’ve treated attacks by humans, bats, cats, ants, rats, microorganisms, motorbikes, automobiles, dogs, scorpions, stingrays, hippos, crocodiles and snakes, but this was a first for me. I didn’t know what I might see as I pulled the blanket off of the man’s head (photos). He was expressionless and had difficulty obeying commands and was in obvious emotional shut-down. His head had a number of deep lacerations, all with sharp edges, like those one sees after a knife fight. A brief exam revealed that bones, muscles and nerves had been violated and that this man had lost a lot of blood. Though I have a lot of experience with many types of lacerations, this would not be a repair best done in our unsterile, bush clinic (if we could get him to our surgery colleagues) and we took him to the little clinic to cleanse and dress the wounds and pray with him, while we made contact with our colleagues with MAF to see if they were available to fly this man to Lubango for surgical repair (they had dropped off Betsy and me the previous day). These passionate servants readily agreed and arrived in less than two hours and he was in Lubango less than three hours after he so rudely interrupted our lunch.
The rest of the story… Apparently, this leopard killed multiple goats over the past few days and the owner of the goats sent these three men (workers at the ranch) to hunt and kill the leopard. They tracked it at first light, with the help of dogs, and found it after about an hour. They shot the animal with a single-shot rifle, but didn’t kill it. Apparently, the injured and angry leopard then scared the dogs (which are usually a good distraction), and they fled behind the shooter, so the cat attacked the shooter before he had an opportunity to reload. The lightening-quick animal viciously leapt for the man and took his head in its mouth, while the dogs attacked and this man’s companions beat on the leopard with machetes. The man had his hands up on the leopard’s head, trying to free himself from its jaws and machete blows were raining down on the leopard’s head. The bite victim lost one finger and had partial amputations of several others from the machete blows trying to free him. One of the companions bravely grabbed the leopard’s head with his hands and tried to pry the jaws from of his friend’s head and was mauled by the cat’s claws, sustaining multiple lacerations on his arms and hands. I can’t imagine the chaos of those few moments! The leopard, weakened from the gunshot and the machete blows, released its victim and succumbed, dying from the struggle. The men then had to recover enough to walk several miles to their ranch owner’s house to get his car to bring the man to us.
We cleansed and dressed the wounds, gave both injured men antibiotics and pain meds (injectable anti-inflammatory in the same class as ibuprofen) and contacted our skilled surgeons via internet to notify them of what they were getting and what we had done. All was arranged for this man to receive excellent care at our mission hospital, CEML, in Lubango, and our colleagues there even sent a car to transport the men from the airport to the hospital… but… our MAF pilot, Brent Mudde, dropped the three men off at the airport terminal… and never saw them again. The ambulance from the hospital never saw them. No one knows what happened to them. We assume that they went by taxi to a public hospital because they didn’t want to (or couldn’t) pay for surgical repair and, based on much familiarity with the care at the public hospitals here, he likely received worse care than we could have provided in the bush.
When I first heard the outcome, I was frustrated because we had arranged care for them with the best – our experienced surgeon colleagues who could teach most plastic surgeons (the stitching experts among surgeons) some things. But there were certainly factors involved beyond my knowledge and control and I must never dictate how another free human being will respond to my intervention. I’m responsible only for my response. Just because I know that certain behavior will produce better results never guarantees that my counsel will be received. This is a source of much frustration in our work among people who have never encountered evidence-based medicine and who have rarely encountered people from another culture, about which they are completely unfamiliar (it’s always difficult to trust someone immediately upon meeting them and who, just by their appearance, is completely different than you). It’s a source of frustration as an elder in my own culture, often dismissed by the next generation, and it’s a source of frustration for a parent, who desires that their kids would benefit from their mistakes/experience/wisdom and avoid some of the pain they’ve endured. I am so humbled by this thought and how I’ve often rejected and/or neglected my Father’s wise counsel to act independently of Him, only to experience the pain His counsel would have prevented!
We were so grateful for the wisdom/experience/counsel of nine engineers (photo) from several countries with Engineering Ministries International (EMI), out of Colorado Springs, CO who came to help us design simple and functional hospital structures and improve the water supply for the villagers in Cavango. We had three visits, each with three people, and so thoroughly enjoyed their hearts and their unique skills. They provided insight we could have found nowhere else, and they came to us! I am looking forward to their reports over coming months. One of the men with EMI has been to many countries over many years, including North Korea and he said that it was more trying (and tiring) to get into Angola than getting into NK!
We have recently been inundated with pertussis in our region. It’s an awful illness, though less severe than most of those we are vaccinated against in the developed world. There is little treatment once one has the illness, but most of us have never encountered this illness because of the highly effective vaccine which most of us have received as children. The problem is that vaccines in rural Angola are available, but often ineffective because they are not kept cold, as they are not transported in refrigeration and most clinics and storage facilities have no refrigeration (or refrigeration units that aren’t working). Many of our pertussis patients have received government-supplied, ineffective vaccinations at our clinic (there is no way to know if the “cold chain” has been violated when we receive the vaccines). If only those in the US who are against vaccines could spend a single night in Cavango listening to these kids cough and fight for breath, most of them for weeks before resolution…
The day before the leopard attack above, we had two MAF planes at the Chinhama airstrip, which is 15mi (an hour drive) from Cavango (photo). We were transporting two patients to Lubango for surgery, a woman with a large pelvic tumor and a one-year-old boy. This boy surprised us all by surviving severe cerebral malaria, coming out of a coma and almost constant seizures for two days, but then he developed, before our eyes and over several days, a rare complication of Falciparum Malaria in which his toes and teeth became necrotic and black (photo). He needed his toes, and possibly his feet, amputated, because of this condition, known as Symmetric Peripheral Gangrene (SPG). It was the first time I had seen this complication from this disease (after treating many thousands) that I have grown to hate. Just in this past week, we’ve had eight kids die within the first several hours of their arrival to our clinic in Cavango, almost all from severe blood loss secondary to red blood cell destruction by the malaria parasite. We have recently ordered kits from the US that will allow us to give these kids some blood so that, hopefully, we will have many fewer deaths from this hideous disease next year.
The Kingdom of God… A man I don’t know has been following our work from the US and read in our blog posts about the many kids we lose to profound anemia caused by malaria’s destruction of red blood cells. He researched giving transfusions in low-resource settings and found a start-up company in the US that is putting together kits that will allow us to give blood safely to these kids. I was blown away when he initiated contact with me and is, even now, sacrificially organizing a way for us to get these kits. Amazing and so beautiful! So many kids’ lives will be saved and none will know this man or the effort he put into their well-being.
Malaria… We have perhaps 30-40 daily inpatients this month and most are in the hospital for a disease other than malaria, but virtually every one ends up with this disease, contracted during their stay in our hospital! I treated a ten-year old girl this morning for malaria who is responding so well to our treatment for her severe, life-threatening miliary TB (whole body), but she will survive the malaria because her father made us aware of her fever the first day. Because our various treatment regimens for malaria are highly effective, this disease is not a killer if treatment is begun in the first few days after onset of fever but, thereafter, kills many children, most often because of the red-cell destruction that occurs over several days.
More malaria… One morning last week I spent two hours repairing a complete laceration of the Achilles tendon in a seven-year-old after his heel got caught in the chain of a motorbike during his transport to our hospital. He had become comatose from malaria during the night and his parents hired a motor bike driver to bring them both to the hospital with the boy. The tendon came together well and we packaged his leg in a positional cast only to have him die from the cerebral malaria that evening.
Maturity… According to Jesus, our maturity is revealed in our preoccupation with Him and our preoccupation with benefiting others, and the lack of preoccupation with ourselves. The world around us communicates the opposite in that we must be preoccupied with self in order to develop as a person. The messages of so many churches, week after week, focus on my growth, my relationship with God, my holiness, my fruit, my peace, my contentment, my salvation, etc and, by doing so, completely miss the other-emphasis of Jesus and His kingdom. He calls us to be preoccupied with Him and with them, not with me!
Basics… It’s tough seeing people every day who have neither the most basic of their needs, nor the opportunity to obtain the same… We dismiss Jesus’ priorities today, and so many suffer as a result. Before Jesus said He would be with us always, for example, He commanded us to GO and do what He did and He would GO with us. We sure hear a lot about His presence with us always, yet so little about abandoning our lives to go where-ever. Jesus admonished us to pay so little attention to our own desires that we don’t even stop following Him to bury our father. Jesus told a story about a wealthy man who died and then begged to change places with the poor man who had suffered horribly under his earthly watch, eating the crumbs that fell from his table. Jesus indicated that, in eternity, justice would prevail and those who suffered would be attended to like they never were in their earthly life and those who spent their riches on themselves would experience the lack that they caused by their earthly consumption. For anyone with earthly prosperity like us (we make about $3000/month and this is more money than anyone we serve here could ever dream of seeing), these verses ought to cause profound anxiety, because there is so much disregarded lack just over the hedge (so many seeking the crumbs from our table). We serve two masters without a thought, not appreciating that Jesus said we are only capable of serving one, while rejecting the other, and our credit card statements reveal which we are serving…
Priorities… We can prioritize so much other than the Kingdom… If only a fraction of what “Christians” spent on sports and entertainment went to those with desperate needs… We think highly of ourselves when we give away our trash (what we don’t want anymore) and from our surplus we contribute a few dollars to “the poor”. Yet the One we claim to follow calls us to, as He did, give away our entire lives for the benefit of others! We are called to be stewards, not consumers… Our resources (time, money, talents, etc) are to pass through our hands. We have the privilege of participating with our Father in the distribution of HIS resources, not spending them on ourselves. We are to spend far more on others than we do on ourselves. We wonder why we don’t experience the fruit of the Kingdom of Jesus when most of our lives are spent at work and the most important things about our job are the salary, “security”, benefits and vacation. We choose the life/work/residence we want and some of us even go on a short-term mission trip and what is the most common take-away that I’ve heard over the years? We are more grateful for what we have! We are grateful that we can return to our prosperous, “blessed” lifestyle, leave behind the suffering, and continue to contribute minimally (compared to what we spend on ourselves) to the radical, man-made injustices in this world. I know this isn’t an easy word, but it applies to me and to many and nothing Jesus said or did was easy, but it was (and is) true…
More or less… The fruit of our all-encompassing pursuit of material comfort, security and prosperity over the past 100-200 years isn’t pretty, yet we sadly continue to call material prosperity “blessing” from God. This is not Jesus’ perspective because He knows that more for me means less for others and Jesus’ Kingdom (and its fruit) is found in the pursuit of more for others and less for me. The fruit of the church’s exhaustive pursuit of personal prosperity and “blessing” is extensive physical and spiritual suffering of millions of people neglected.